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NY Health Insurer Fined $700,000
Posted By Joseph Spector On January 17, 2013 @ 12:43 pm In Uncategorized | Comments Disabled
HealthNow was fined $700,000 by the state Department of Financial Services for not informing customers about coverage and benefits, Gannett’s Haley Viccaro reports.
The Buffalo-based insurer failed to explain coverage, benefit rights and how to appeal claims denials to about 164,000 health-plan members.
“Consumers have a right to know what their health plans cover, what the plans don’t cover, and what they can do when their claims have been denied,” Superintendent of Financial Services Benjamin Lawsky said in a statement.
HealthNow did not provide explanation of benefits statements to customers and also didn’t give members written acknowledgement of grievances within 15 business days; both are required under state law, Lawsky said.
The company didn’t file certificates of appointments for agents and also failed to provide timely notices of appointment of agents, notify the department of termination of agents or ensure that commissions were paid by licensed producers, Lawsky said.
HealthNow said they will take steps to prevent the violations from occurring in the future by revising procedures in sending explanation of benefits statements to customers.
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